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New Patient Care Model Assesses if Elderly can Live on Their Own

June 24, 2009

HOUSTON – (June 24, 2009) – A team consisting of medical professionals, social workers and family members plays an important role in assessing an older adult’s capacity to live on their own, according to experts at Baylor College of Medicine (www.bcm.edu *) and the Michael E. DeBakey Veterans Affairs Medical Center (http://www.houston.va.gov/) at Houston in a paper published in the Archives of Gerontology and Geriatrics.

After identifying a patient population of older, frail adults likely to have difficulty living independently because of social issues, impaired reasoning skills or other chronic conditions, researchers developed an innovative method to determine whether these older adults were not adequately caring for themselves and needed assistance.

“We realized there was no model for the most effective way to diagnose older adults who had been self-neglecting, to assess them and decide if they can or can’t live independently and what to do about it. After realizing this gap, we tried to create a clinical protocol that provided both assessment and intervention at the same time,” said Dr. Aanand Naik, assistant professor of medicine at BCM and a health services research investigator in the Health Decision-Making and Communication Program at the VA Health Services Research and Development Center of Excellence, Michael E. DeBakey Veterans Affairs Medical Center.

The first step of the process involves getting referrals from family members, social workers or a county’s adult protective services agency about an older adult who may or may not have the capacity to live by himself or herself. Next, a geriatrician (a physician who specializes in care of the elderly), social worker and case worker visit the person’s home as part of a comprehensive assessment.

“The assessment is ideally done in the patient’s home because you really want to get a sense of what the living environment is like,” said Naik, who is also a geriatrician with BCM’s Huffington Center on Aging.

The comprehensive home assessment includes evaluating the adult’s medical and psychosocial situation, as well as a series of tests and interviews to measure depression and the ability to make decisions.

“People who self-neglect usually have some sort of cognitive dysfunction, and it may be difficult to identify until the decision-making interview, during which they are asked about self-care, hygiene and financial management,” said Felicia Skelton, first author of the paper and fourth-year medical student at BCM. “You see the deficits when you start to ask questions about decision making.”

After the assessment, geriatricians, social workers and family members meet to discuss the situation and possible interventions. Interventions can vary from frequent visits by a family member who helps the person to recommending placement in a nursing home.

“We want the least invasive intervention as possible so that the adult can still remain independent,” said Skelton.

After recommendations are made, the team creates a follow-up plan to ensure that the adult’s situation is improving.

“It’s an eye-opening experience once you see what effect you can have on these people’s lives,” said Skelton. “We are trying to find a middle ground, and this is why it’s a collaborative effort.”

“It’s important to get everyone on the same page,” said Naik. “We are hoping that other physicians are able to incorporate this evaluation as well.”

Funding for the research came from the John A. Hartford Foundation and the Medical Student Training in Agency Research program funded by the National Institute on Aging, administered through the American Federation for Aging Research and local support from BCM’s Huffington Center on Aging.